White matter disease and sleep-disordered breathing after acute stroke

Neurology ◽  
2003 ◽  
Vol 61 (7) ◽  
pp. 959-963 ◽  
Author(s):  
J. Harbison ◽  
G. J. Gibson ◽  
D. Birchall ◽  
I. Zammit-Maempel ◽  
G. A. Ford
SLEEP ◽  
2004 ◽  
Vol 27 (3) ◽  
pp. 474-479 ◽  
Author(s):  
Jingzhong Ding ◽  
F. Javier Nieto ◽  
Norman J. Beauchamp ◽  
Tamara B. Harris ◽  
John A. Robbins ◽  
...  

SLEEP ◽  
2016 ◽  
Vol 39 (4) ◽  
pp. 785-791 ◽  
Author(s):  
Sara K. Rostanski ◽  
Molly E. Zimmerman ◽  
Nicole Schupf ◽  
Jennifer J. Manly ◽  
Andrew J. Westwood ◽  
...  

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Vishal Shah ◽  
Ashrai Gudlavalleti ◽  
Julius G Latorre

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.


2009 ◽  
Vol 27 (1) ◽  
pp. 104-110 ◽  
Author(s):  
Pere Cardona Portela ◽  
Jaume Campdelacreu Fumadó ◽  
Helena Quesada García ◽  
Francisco Rubio Borrego

Cureus ◽  
2020 ◽  
Author(s):  
Nobuto Nakanishi ◽  
Yasuhiro Suzuki ◽  
Manabu Ishihara ◽  
Yoshitoyo Ueno ◽  
Natsuki Tane ◽  
...  

Author(s):  
Nancy Gadallah ◽  
Danisette Torres ◽  
Arifa Ghori ◽  
Laura Suhan ◽  
Spozhmy Panezai ◽  
...  

Introduction : The relationship between embolic stroke and patent foramen ovale (PFO) is well‐established. Our objective was to evaluate the association between high intensity transient signals (HITS) in contrast‐enhanced transcranial doppler ultrasonography (ceTCD), baseline MRI brain small vessel ischemic changes, and rates of acute ischemic stroke in the setting of focal neurological deficits. Methods : Electronic medical records of subjects with acute onset neurological symptoms who had ceTCD and MRI brain were evaluated. Subjects without a reported Spencer grade and/or MRI brain without available DWI and FLAIR sequences were excluded. Acute stroke rates and baseline Fazekas score in low‐grade (Spencer grade 1–2) and high‐grade (Spender grade 3–5) shunts were analyzed using Z score for 2 population proportions and Mann‐Whitney U test, respectively. Social Science Statistics was used for data analysis. Results : From June 2016 to August 2021, of 7,498 consecutive ischemic stroke patients, 132 patients were identified as possible strokes related to PFO and were hospitalized with focal neurological deficit, underwent ceTCD and MRI brain. Acute stroke was confirmed on DWI in 60% of Spencer grade 1 (n = 73), 72.2% of grade 2 (n = 19), 72.7% of grade 3 (n = 29), and 80% of grades 4 and 5 shunts (n = 11). Acute stroke rates between low grade (grades 1–2) and high grade shunts (grades 3–5), did not reach statistical significance (z = ‐0.9181; p = 0.17879). There was no significant difference in periventricular white matter disease (z = 0.85697; p = 0.19489). Fazekas scores assessing deep white matter disease were statistically significant between low‐ and high‐grade shunts (z = 1.92818; p = 0.0268 Conclusions : A trend towards statistical significance was observed in high‐grade shunt association with higher rate of acute stroke. Deep white matter disease burden may be significantly higher in high‐grade shunts. Further prospective studies are needed to corroborate our findings.


2014 ◽  
Vol 19 (1) ◽  
pp. 3-3
Author(s):  
José Haba-Rubio ◽  
Daniella Andries ◽  
Vincianne Rey-Bataillard ◽  
Patrik Michel ◽  
Mehdi Tafti ◽  
...  

2020 ◽  
Vol 30 (4) ◽  
pp. 485-492
Author(s):  
A. G. Chuchalin ◽  
T. G. Кim ◽  
L. V. Shogenova ◽  
M. Yu. Martynov ◽  
E. I. Gusev

The article presents an overview of the problem of respiratory failure in patients with acute stroke, its prevalence, leading pathophysiological factors, clinical features, and diagnostic methods. Stroke is the third leading cause of death worldwide. Stroke survivors often experience medical complications that may be the direct cause of mortality. The syndrome of respiratory failure and respiratory complication are common after stroke. The syndrome of respiratory failure syndrome of varying severity is following after stroke in 44 – 90%, often remains undervalued, undiagnosed, due to the clinical features of this category of patients. The nature of these disorders depends on the severity and site of neurological injury. Abnormality of breathing control, respiratory mechanics, and breathing pattern are common and may lead to gas exchange abnormalities or the need for respiratory support. The leading symptom is hypoxemia, which is often hidden, and may be detected by examining of arterial blood gasses (PaO2, PCO2). Stroke can lead to sleep disordered breathing such as central or obstructive sleep apnea. Sleep disordered breathing may also play a role in the pathogenesis of cerebral infarction. Venous thromboembolism, swallowing abnormalities, aspiration, and pneumonia are among the most common respiratory complications of stroke. Neurogenic pulmonary edema occurs less often but may be very dramatic. Therefore, early diagnosis, prevention and treatment are important in reducing mortality and improving functional rehabilitation.


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